In Office Treatments

During your visit, Dr. Pappas will gather a thorough history of your symptoms, prior treatments and your general health. Dr. Pappas will perform a complete neurological examination. This is the first step in determining your diagnosis and is often the most important one.

Trigger Point Injection (TPI)

Trigger point injections are used to treat painful areas of muscle spasms. Normal muscle contracts and relaxes when it is active. A trigger point is a knot or tight, ropy band of muscle that forms when muscle fails to relax. For the TPI, a small needle is inserted into the trigger point and a local anesthetic (lidocaine) with or without a corticosteroid is injected. Injection of medication inactivates the trigger point and alleviates pain.

The procedure takes 5-10 minutes and no preparation on the part of the patient is needed. Sustained relief usually is achieved with a brief course of treatment. The injection may cause a small amount of discomfort that lasts a few seconds.

Occipital Nerve Block

This procedure is most commonly used to treat occipital neuralgia, but has been also been shown to help in some cases with migraines and tension type headaches and headaches originating in the neck vertebra.

An occipital nerve block is an injection of a steroid and local anesthetic around the greater and lesser occipital nerves that are located on the back of the head just above the neck area. The steroid injected reduces the inflammation and swelling of tissue around the occipital nerves. This may in turn reduce pain caused by inflammation or irritation of the nerves and surrounding structures.

This procedure takes less than 2 minutes and requires no preparation.

Botox Injections

Botox injections are now FDA approved for patients with severe and frequent migraine headaches which have not responded to migraine preventative medications.

The treatment with Botox for frequent migraines consists of a series of 31 injections using a very fine needle over 7 key areas of the head, neck and shoulders. The injections cause only minimal discomfort and take 5-10 minutes to perform. The injections are given every 3 months. Further improvement in headaches usually develops over time with repeated injections.